A major surgical problem is imposed when late complications occur in patients submitted previously to aortic root replacement by the Bentall-De Bono technique. During an 11 years period, from January 1976 to December 1986, 37 patients had aortic root replacement with valved conduits and 5 presented late complications (13.5%) requiring a new operation. The lesions were: biological valve degeneration, infective endocarditis and suture leaks leading to pseudo aneurysm, peritubular leakage and hemolysis. There was 1 systemic embolization with an infected vegetation. The 5 patients were re-operated, with 1 surgical death (20%), in a case presenting fungal endocarditis (Aspergillus), due to uncontroled bleeding. The remaining 4 had an uneventful hospital course. There was 1 late death during a surgical exploratory thoracic procedure. The remaining 3 patients enjoy a normal active life. One of these still has a small peritubular leakage causing mild aortic regurgitation and hemolysis. The surgical procedure consisted of Dacron tube replacement preserving the implanted valve prostheses in the 2 cases with infective endocarditis. Two ruptures biological valves were replaced by methalic disc valves. In this situation, the Dacron tubes were preserved and the valves approached through a longitudinal incision in the tube. The suture leaks were corrected with direct isolated mattress sutures. Late re-operations may be required after aortic root replacement with composite valve-tube grafts. They can be performed at an acceptable surgical risk. The technique should be as conservative as possible and directed to the causing lesions, preserving the remaining structures. A methalic prosthesis should be the first choice for the primary procedure, in order to avoid late tissue degeneration.
Bentall-De Bono operation